Increasing incidence of fungemias in a community hospital

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Abstract:

Candidal bloodstream infections are increasingly recognized in critically ill adult and pediatric populations, with significant
associated morbidity and mortality. In 2003 an increase in fungemia was noted in adult patients and historical data showed an
increase over the previous 18 month period baseline. Issues examined were underlying risk factors, management of blood
glucose levels, central lines, intravenous fluids, environmental sources, antibiotics and anti-fungals, heparin flush and
hyperalimentation. Candidal nosocomial bloodsream isolates (21%), ranked second after coag neg staph 50%, MRSA and
MSSA 17% and 12%, for the period 2002-2004. Mortality rates associated with fungemias were 52% (13/28) in 2002; 47%
(26/55) in 2003 and 34% (22/64) in 2004. For catheter related candidemia , C. glabrata, was the second most common isolate
(32%) in 2002, 26 % overall for the period 2002-2004; other non albicans species were C. parapsilosis (17%) and C. tropicalis
(10%). Risk factors included intravenous lines, prolonged hospitalization, steroids, TPN, ICU stay, poor glucose control and
prolonged use of antibiotics. Infection rates based on TPN days for 2002 and 2003 revealed no trends in NICU population
receiving antifungal prophylaxis for their first six weeks of life. We observed a significant increase in adult nosocomial
fungemia rates beginning in August 2003, in patients receiving TPN. We conducted a case control study (40 fungemia patients
on TPN, 37 TPN pts without fungemia ) : serum glucose of > 120 mg/dl resulted in an odds ratio of 2.6 of developing
fungemia, risk factors had a odds ratio of 2.2, but had only marginal statistical significance at p=0.09. No other factor reached
statistical significance including 2-in-1 Vs 3-in-1TPN. Since August 2004 fungemia rates have returned to baseline. Infection
control programs and proactive intervention are essential in at least minimizing and controlling the rising incidence of
nosocomial candidemia.